CPA Eligibility Determination Form FY27

CPA Eligibility Determination Form FY27

City of Somerville Community Preservation Act Fund
Please contact Community Preservation Act Manager, Roberta Cameron, with questions about this form. rcameron@somervillema.gov
Project Name:
Project Location:
Property Owner:
Applicant Name/ Organization/ Department:
Contact Person:
Mailing Address:
Phone:
Email:
Approximate amount of funds to be requested:
Which of the program areas fits the the primary purpose of the CPA funds you are requesting?

Historic PreservationOpen Space / Outdoor Recreation
Please check all of the following activities that describes your project:

AcquireCreatePreserveRestore or Rehabilitate
Does your project pertain to a physical asset such as a building, structure, land, or object?

YesNo
Would the public be able to view and/or access the asset?

YesNoMaybe
Who owns the property or asset?

I own it.My organization owns it.The City of Somerville is the owner and the applicant.The City of Somerville is the applicant for a property owned by another entity.The City of Somerville is the owner and I have permission to apply on behalf of the City.I have the owner's agreement to apply for a grant together.The asset is owned by a condominium association and the members and trustees consent to apply for this grant.A parent organization has oversight over real estate decisions respecting this asset, and consents to apply for this grant.Other
Which Department will oversee this project?
Contact Name of City Staff
Co-Applicant or Partner
Contact Name of Co-Applicant or Partner
Does another organization or entity have use or control of this property?

YesNo
Please Describe
Narrative Questions
Project Summary:
Project Status:
- Is the site owned by the City of Somerville or another public entity?
  
  YesNo
- Is the property currently protected under a deed restriction, Article 97, or other form of permanent protection?
  
  YesThe site is expected to be placed under permanent protection.No
- Please explain:
  Describe the form or status of protection.
- If no, what is the long-term assurance that the site will be maintained as open space or outdoor recreation use?
- Is the resource in a Local Historic District and/or listed on the State Register of Historic Places? (you can check designation by looking it up in Somerville’s Local Historic District database or the Massachusetts Cultural Resource Information System)
  
  YesNo
- If no, has the Somerville Historic Preservation Commission previously made a determination that the resource is significant?
  
  YesNo
- If no, the Historic Preservation Commission (HPC) must give a determination of historical significance for the project to be eligible for CPA funding. Please refer to the Guidelines for Determination of Historic Significance and answer the following questions:
- How is this resource important to Somerville's History?
- How does this resource meet the criteria for quality or integrity as described in the HPC Guidelines?
- The CPA Application Supplement provides sample forms and conditions which will be part of grant agreements that are required to be executed before funds will be disbursed.
  
  Please review the following list and check each box to acknowledge that you have reviewed this material and consent to sign these forms if applicable, and agree to CPA conditions if your grant is approved.
- CPA Grant Agreement*
  
  Grant Agreement General ConditionsDisbursement Guidelines
- City of Somerville Standard Contract Forms*
  
  General Grant AgreementCertificate of AuthorityEvidence of InsuranceCertificate of Good Standing (MA)Side Guard Ordinance AcknowledgementTax Exemption AcknowledgementCampaign Contribution DisclosureSomerville Living Wage Ordinance Acknowledgement
- Sample Restrictions*
  
  Preservation RestrictionConservation RestrictionPublic Access Agreement
- Use checklist below to mark the attachments provided.
- Property Owner Consent
  
  Documentation of site control or written consent of the property owner to undertake the project
- Condominium Consent
  
  Written consent of condominium association to undertake the project
- Partnership
  
  Documentation of agreements with partner organizations, if applicable (i.e., license agreements, leases)
- Restrictions
  
  Documentation of any existing permanent protection that has been applied to the property
- Historic Preservation
  
  Documentation that the project is listed on the State Register of Historic Places or previous written determination from the Somerville Historic Preservation Commission that the resource is significant in the history, archeology, architecture, or culture of Somerville
- Submit attachments here or email to rcameron@somervillema.gov. Please combine all required and optional attachments into a single PDF before uploading.
  
  Cancelof
- Should be Empty:

CPA Eligibility Determination Form FY27

Narrative Questions